A study at Rhode Island Hospital observed staff on 161,526 occasions to monitor how often they cleaned their hands between July 2008 to December 2012 and found that hand hygiene compliance improved from 60 percent to 89 percent. The study is published online in advance of print in the journal Infection Control and Hospital Epidemiology.

The investigators found there was greater hand hygiene compliance when health care workers were leaving patient rooms, when going in or out of the room of a patient that was known to be infected or colonized with antibiotic-resistant bacteria, and when caring for patients during the evening shift. In the publication, the investigators also outlined the infection control and prevention program utilized at Rhode Island Hospital that significantly improved hand hygiene compliance among doctors, nurses and support staff.

Hospital-associated infections have a significant impact on health care in the U.S. According to the Centers for Disease Control and Prevention (CDC), in 2002, such infections developed in 1.7 million patients and were associated with nearly 100,000 deaths. In 2009, the CDC estimated that the annual direct medical costs of such infections in U.S. hospitals was $36 billion to $45 billion.

"Hand hygiene is the most important intervention to reduce the risk of hospital-associated infections, but many hospitals have struggled to develop a culture of safety where high hand hygiene compliance becomes the norm rather than the exception," says principal investigator Leonard Mermel, DO, medical director of the department of epidemiology and infection control at Rhode Island Hospital. "With use of a process improvement program that engaged hospital administration at the highest levels, as well as hospital staff from housekeepers, to facilities engineers, to nurses, doctors and others, we were able to dramatically improve our hand hygiene compliance in a sustainable fashion, thereby reducing the potential for harm in our patients."

There was no funding for this study. Mermel's principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. He also has an academic appointment at The Warren Alpert Medical School of Brown University, department of epidemiology and infection control. Other researchers involved in the study are Julie Jefferson, RN, MPH; and Benjamin Kowitt, MD, both are affiliated with Rhode Island Hospital and/or Brown University.